Symptoms Of Colic Research Articles

S1726 Eosinophilic Infiltration Causing Biliary Tree Obstruction Without Stricture

Introduction: We present an exceedingly rare case of eosinophilic cholangitis (EC) without stricture. Of the 40 cases of EC reported in the literature, fewer than 10 cases did not involve a stricture. Case Description/Methods: A 60-year-old female with no significant past medical history presented with symptoms of biliary colic for 2 days. Laboratory results were significant for elevated hepatobiliary enzymes including alkaline phosphatase of 300 IU/L and total bilirubin of 3.8 mg/dL. A hepatobiliary iminodiacetic acid scan was performed with an absence of radiotracer excretion into the biliary tract. However, a magnetic resonance cholangiopancreatography showed no obstructing stone, stricture, or lesion. A broad workup including hepatitis and autoimmune serologies was negative. The patient underwent an uncomplicated laparoscopic cholecystectomy, and direct inspection of the gallbladder confirmed significant edema. Histopathology of the gallbladder showed acute and chronic acalculous cholecystitis with eosinophilic rich infiltrates. Notably, the patient had an absolute eosinophil count of 1.2 cells/µL. She was diagnosed with eosinophilic cholangitis and treated with corticosteroids. At her one-month follow-up, her symptoms had resolved. Discussion: Eosinophilic cholangitis is a rare, self-limiting condition featuring eosinophilic invasion of the biliary tree. Laboratory values in EC reflect an obstructive process, but diagnosis is frequently delayed as both symptoms and imaging mimic multiple other biliary conditions including malignancy, primary strictures, primary sclerosing cholangitis, amongst others. Endoscopic dilation of strictures often provides a surprising diagnosis when pathology demonstrates dense infiltration of eosinophils. Although a majority of EC is associated with stricture, EC may also present with obstructive features in the absence of stricture. Likewise, peripheral eosinophilia may or may not be present. Risk factors for EC have not been established. Literature suggests that patients with pre-existing eosinophilic processes such as eosinophilic esophagitis and asthma are more likely to develop EC than the general population. There is no standard treatment, but corticosteroids have demonstrated empiric efficacy, similar to the other eosinophilic processes mentioned. Increased physician awareness of eosinophilic cholangitis will help prevent delays in diagnosis and initiation of effective medical therapy.

Probiotics added to maternal nutrition affect ınfantile colic symptoms and fecal microbiota profile: a single-blind randomized controlled study.

Infantile colic has a multifactorial etiology; although various treatments have been attempted to manage and alleviate its symptoms, a solution is lacking, adversely affecting mothers and their babies. Recent studies have suggested that dysbiosis may play a role in the pathogenesis of infantile colic and that modulating the gut microbiota, including the use of probiotics, may aid its management. This single-blind randomized controlled study evaluated the effect of probiotics (Actiregularis, 5×106) added to the diet of mothers on infantile colic symptoms and neonatal gut microbiota content. A probiotic drink containing the Actiregularis (5× 106) strain was added to the diet of mothers in the experimental group once daily for 15 consecutive days. Stool samples were collected from each infant twice, on days 0 and 15, and fecal 16s rRNA gene sequencing and compositional-based metabolomic analyses were performed. The mothers recorded the babies' crying frequency and severity for 15 days using a daily form created by the researchers. This study was registered at ClinicalTrials.gov (ID: NCT04374955). Infants whose mothers were supplemented with Actiregularis for 15 days showed a decreased frequency (P= 0.00) and intensity (P<0.001) of crying as well as a significantly increased bacterial diversity in the stools (P=0.017). This variety was substantially affected by the addition of probiotic products. The greatest species diversity was observed in the group treated with probiotics, while the least diversity was observed in the control group (Shannon, P=0.0043; Simpson, P=0.017). Babies treated with Actiregularis added to their mother's diet for 15 days showed decreased crying frequency and intensity and increased bacterial diversity and density.

The Therapeutic Benefits of Single and Multi-Strain Probiotics on Mean Daily Crying Time and Key Inflammatory Markers in Infantile Colic.

Infantile colic is a functional gastrointestinal disorder in which a healthy infant displays paroxysms of intense crying or fussiness. Although this condition is self-limited, it causes significant distress for parents and may be linked to long-term health concerns for children. The microbiome of infants with colic has been correlated with increased dysbiosis or imbalance of commensal bacteria. This dysbiosis may ultimately lead to changes in infants’ immunological profiles, favoring markers linked to inflammation, including specific cytokines, calprotectin, and genetic markers. Therapeutic regimens such as probiotics may be helpful in modifying the gut microbial composition, thereby influencing the presence of inflammatory markers and potentially reducing colic symptoms in infants. This review provides a summary of the findings from 10 randomized, placebo-controlled, double-blinded studies conducted in the past five years with the aim of examining the potential therapeutic benefits of probiotics in infantile colic. The articles were selected through PubMed and Google Scholar using the keywords infantile colic, microbiome, probiotics, cytokines, dysbiosis, inflammatory markers, and lactobacilli. We summarize the results of these studies to explore the potential anti-inflammatory therapeutic benefits of single and multi-strain probiotic formulations on daily crying time and key inflammatory markers in infants with colic. The research largely shows the beneficial role of probiotics, largely of the lactobacillus genus, in the reduction of colic symptoms and the reduction of key inflammatory markers. However, some studies demonstrated an insignificant effect of certain probiotic strains in symptom management. Further research is necessary to better understand the anti-inflammatory properties of probiotics and determine the role this could have on the manifestation of colic in infants.

SP10.1.4 Association between public holidays and acute admission with biliary colic: a retrospective analysis

Abstract Introduction Biliary colic symptoms are often post-prandial, particularly following fatty foods. Public holidays and festive periods are frequently celebrated using such foods. We aimed to determine the rates of admission following public holidays at a Scottish district general hospital. Methods Emergency admissions with biliary colic from June 2016 to June 2019 were included. Public holiday dates were extracted from the Scottish government website. To include those with delayed presentation, the 3-days following a public holiday were also considered to be public holiday-related (PHR). Statistical analysis was performed to determine any differences in demographics or outcome. Results Of the 273 patients included, 1 (0.4%) was admitted on a public holiday with a further 27 (9.9%) admitted on a PHR day. PHR days accounted for 104 (9.2%) of the 1125 days included in the study. Comparing those admitted on a PHR and non-PHR day, there was no difference in age (61.6 vs 61.1 years, p=0.895), female gender (75 vs 66.5%, p=0.365), length of stay (6 vs 4 days, p=0.250) or operative intervention (53.5 vs 37.6%, p=0.09). Conclusion The majority of PHR admissions with biliary colic occur during the 3-days following a public holiday. It is therefore likely that the need for radiological investigation and access to emergency theatre will be greater during this period. Future work could assess the impact of other cultural holidays which are not reflected in public holidays.

Effectiveness of probiotics for the treatment of infantile colic.

Infantile colic is one of the most common health issues that can occur during an infant's first months of life, affecting approximately 20% of all infants. The aetiology of infantile colic is not well understood; however, studies have suggested that changes in the intestinal microbiota can lead to symptoms of infantile colic. For this reason, different strains of probiotics have been studied to help understand their effectiveness in the treatment of infantile colic. The aim of this evidence-based review isto summarise the evidence of the effectiveness of probiotics in the treatment of infantile colic. Several strains of probiotics have been studied, with some presenting positive results for reducing the symptoms of infantile colic in groups with specific characteristics. However, more studies are required to evaluate efficacy and effectiveness of probiotics in different degrees of severity and in larger and more heterogenous samples.

Computer tomography of uro-lymphatic fistulas associated with renal colic

This article presents two clinical observations of uro-lymphatic fistulas diagnosed by computed tomography. In both cases, the patients were admitted with symptoms of renal colic. Uro-lymphatic fistulas are a rare condition caused by the formation of a connection between the urinary and lymphatic systems, which is caused by, as a rule, lymphatic vessel obstruction due to parasitic infestation. Other causes may be radiation therapy, retroperitoneal trauma, and tumor sprouting. In the era before antibiotics, infectious processes such as xanthogranulomatous pyelonephritis and renal tuberculosis were common. Cases of uro-lymphatic fistulas formed against urolithiasis background are presented below. In the clinical cases presented, urine directly entered the lymphatic vessels through a uro-lymphatic fistula detected on contrast-enhanced computed tomography. Uro-lymphatic fistulas caused by impaired urine outflow due to blocked urinary tract are rarely detected since abdominal ultrasound is the diagnostic method of choice in renal colic. In the vast majority of cases, uro-lymphatic fistulas are treated conservatively and do not require surgical intervention. As a rule, the formed fistulas cease to exist when its root cause is successfully treated.

Are there seasonal variations in renal colic in uric acid stone formers in Germany?

Seasonal variations in renal colic have been described by many authors for different countries worldwide. In most studies, there was no differentiation with regard to stone composition. Recently, we demonstrated that there was no seasonal variation in renal colic and urine chemistry for calcium oxalate stone formers in Germany. As we have many uric acid stone formers (UASFs) in our region, we were interested in learning the situation of this type of stone. We studied 286 consecutive UASFs with symptoms of renal colic. We divided them into four groups according to the quarters of the year. For stone analysis, X-ray diffraction/polarizing microscopy was used. Additionally, the following general parameters were examined in all patients: age, BMI, blood pressure, stone frequency, diabetes mellitus; blood: creatinine, glucose, uric acid, calcium, sodium and potassium; urine: pH, volume, calcium, uric acid, citrate, ammonia, and urea. Using the statistical program Prism 5 (GraphPad Software, San Diego, USA), significant differences between the four groups were calculated by the Kruskal-Wallis test. We observed significantly more UASFs with renal colic in the third and fourth quarters of the year. This is in contrast to our findings in calcium oxalate patients. However, there was no variation in metabolic parameters. The reasons are unclear; different temperatures are not a sufficient explanation, as one quarter is in the warm season and the other one is in the cold season. Unfortunately, no data have been reported in the literature thus far. Further studies are required to better understand these findings.

National diagnostic reference levels based on clinical indications and patient size for adults’ computed tomography in the Kingdom of Bahrain

PurposeThe study aims to establish national diagnostic reference levels (NDRLs) for computed tomography (CT) examinations performed on adult patients based on clinical indications, patient gender, and size in the Kingdom of Bahrain. MethodsThe volume CT dose index (CTDIvol) and dose length product (DLP) were collected between September 2020 and September 2021 from 63% of the total number of CT scanners in the country (five out of eight CT scanners). The data were collected from at least ten patients for eight common clinical indications in the head, abdomen-pelvis and chest-abdomen-pelvis (CAP) regions. The NDRLs were calculated for each clinical indication as the third quartile of the CT scanners' median values of CTDIvol and DLP. They were also calculated based on the patient's gender (for the head) and their size (for the abdomen-pelvis and CAP clinical indications). ResultsFrom 1665 CT examinations, the NDRLs in term of CTDIvol were 67, 66, 67, 13, 14, 17, 19, and 15 mGy for symptoms of headache, trauma, stroke, flank pain, renal colic, abdominal pain, diverticulitis/appendicitis and oncologic follow-up, respectively. Likewise, these were 1206, 1286, 1152, 690, 779, 972, 1061, 1073 mGy cm in terms of DLP, respectively. For large size patients, NDRLs in terms of CTDIvol were on average 1.7 times higher than those from medium size patients for all the clinical indications in the abdomen-pelvis and CAP regions. ConclusionThe NDRLs were established for the most common clinical indications in the Kingdom of Bahrain. They are higher than those established in the literature, thus emphasizing the urgent need of an optimization strategy for better patient radiation protection.

Pediatric Normokinetic Biliary Dyskinesia: Pain with Cholecystokinin on Hepatobiliary Iminodiacetic Acid Scan Predictive of Symptom Resolution After Cholecystectomy.

Introduction: Biliary dyskinesia is typically defined as a gallbladder ejection fraction (EF) <35% on hepatobiliary iminodiacetic acid scan with cholecystokinin stimulation (CCK-HIDA) testing. Cholecystectomy often leads to resolution of associated biliary colic symptoms. Alternatively, there is a subset of symptomatic patients with normal gallbladder EF on CCK-HIDA. It has been proposed that pain with CCK injection is more predictive of symptom resolution after cholecystectomy than low gallbladder EF. We reviewed our experience with pediatric patients with positive CCK provocation testing and a normal gallbladder EF in the absence of gallstones. Materials and Methods: We retrospectively reviewed the records of all pediatric patients with normal hepatobiliary iminodiacetic acid EFs (35%-80%) and pain with CCK injection at a tertiary care center between 2016 and 2020. Age, gender, body mass index (BMI), CCK-HIDA results, and pathology analysis were noted. Short- and long-term resolution of symptoms was determined by patient self-reporting at a mean of 3 weeks and 46 months, respectively. Results: Seventeen patients met inclusion criteria. Average age was 15.1 years (range, 12-17 years) with median BMI 24.9 (± 4.9 kg/m2). Mean CCK-HIDA EF was 56.3% (± 11.4%). In total, 62.5% of patients had evidence of chronic cholecystitis and/or cholesterolosis on pathology analysis. Of patients available for short-term and long-term postoperative follow-up, 80% and 83% reported complete or near complete resolution of symptoms, respectively. Conclusions: Normokinetic biliary dyskinesia is poorly understood but appears to be associated with chronic inflammation and cured by surgical intervention. Laparoscopic cholecystectomy results in resolution of symptoms for a majority of patients and should be considered in those with pain with CCK injection despite normal imaging studies. Clinical Trial Registration Number: 1657640-2.

The effect of symbiotic in the treatment of infantile colic: A double-blind, randomized, placebo-controlled clinical trial.

Background:This study aims to evaluate the effect of symbiotic (Pedilact) on the treatment of infantile colic.Materials and Methods:In this randomized clinical trial in Zanjan, Iran, 76 infants with infantile colic were assigned to two groups of 38 cases using block randomization. The intervention group received 5 drops of Pedilact, a symbiotic containing Lactobacillus reuteri and simethicone (20 mg twice daily), and the control group received placebo in addition to simethicone for 4 weeks. Daily crying time, number of crying attacks per day, and sleep duration were recorded on days 1, 7, 14, 21, and 28, and the results were compared.Results:Thirty-three infants in the intervention group and 35 infants in the control group were enrolled. There was no significant difference between the two groups in terms of age, gender, gestational age, maternal age, type of delivery, type of feeding, and weight at the beginning and the end of the study (all P > 0.05). Daily crying time in the control and intervention groups decreased from 240 and 210 min/day, respectively, to 0 min/day in both the groups. Daily crying attacks decreased from 5 and 4/day in the control and intervention groups, respectively, to 0/day. Sleep duration in both the groups increased from 720 to 840 and 930 min/day in the control and intervention groups, respectively, but the changes were not significant (P = 0.56, P = 0.52, and P = 0.13, respectively).ConclusionWe did not find a significant improvement in colic symptoms in infants receiving symbiotic compared to placebo.

Efficacy of Aromatherapy for Night Crying in Infants with Infantile Colic: A Double-Blind Randomized Controlled Trial.

Too much crying is a self-limiting problem and disappears within a few weeks. However, it can lead to maternal depression and parental stress. This study aimed to evaluate the effect of lavender oil inhalation on the duration of night crying within a week of intervention among infants with infantile colic. In this double-blind randomized clinical trial, the inclusion criteria for infants were being healthy, not taking any medications for colic, having an episode of crying two hours a day, and having a healthy mother. The intervention group received lavender oil inhalation and the control group received sweet almond oil inhalation for seven days. The data pertaining to the duration of crying were collected four times a day (morning, afternoon, evening, and night) via telephone contact. Mothers' mood scores were also assessed at the beginning of the study and on the seventh day of the intervention. At first, the two groups were not different in terms of the duration of crying. After the intervention, however, a significant difference was observed in this regard on all seven days of the study (P < 0.001). Based on the results of the repeated measures analysis, the difference between the two groups was statistically significant (P < 0.001). The results showed that inhalation of lavender oil at low concentrations could reduce colic symptoms and improve maternal mood.

Intraoperative Diagnosis of Gallbladder Agenesis.

Gallbladder agenesis is a congenital anomaly that often presents with symptoms of biliary colic. Due to the rarity of this condition, it is often difficult to diagnose pre-operatively. Here we present a case of a 33-yo female with a 6-month history of right upper quadrant abdominal pain and associated nausea. With false-positive imaging findings of cholelithiasis on ultrasound examination, an incidental intraoperative diagnosis of gallbladder agenesis was made during a routine elective laparoscopic cholecystectomy. This finding was confirmed with postoperative magnetic resonance cholangiopancreatography. The primary aim in reporting this case is to further promote awareness of this rare condition out of concern for increased risk of iatrogenic operative injury in the setting of a condition where conservative management is recommended.

Comparison of the Effect of Abdominal Massage and Hugo Point Acupressure on Infantile Colic Symptoms

Introduction:Colic causes tension in the parents and other family members..,Objective:This study aimed to compare the effect of abdominal massage and Hugo point acupressure on infantile colic symptoms Method:In this clinical trial study, all infants referred to Sheikh, Imam Reza and Akbar Hospitals diagnosed with colic by a physician were recruited after obtaining the consent of their parents and their mothers’ written consent. A total of 114 infants were selected by convenience sampling and 4 sample blocks were randomly divided into three groups, respectively. Individual practical training was provided to mothers in three groups of A (abdominal massage), B (Hugo point acupressure), and C (position) in a 45-minute session and routine training was provided on colic pain, diet modification, how to burp the baby, and proper breastfeeding, The duration of 24-hour colic crying and 24-hour sleep time was recorded for four weeks, and compared at the end of the study using statistical tests.Findings:The mean and standard deviation of the duration of crying at 24 h were significantly different between the three groups in the second, third, and fourth weeks, which indicates the result of the decrease in the duration of 24-hour crying in infants with colic.Conclusion:Finally, it can be concluded that acupressure has an increasing effect on sleep duration and a decreasing effect on the colic score and crying duration compared to the other two groups.

Infant colic: where is the line between norm and pathology, the role of disruption of the intestinal microbiome

Infant colic is one of the most common functional disorders of the gastrointestinal tract in children of the first year of life, worsening the condition of both the child himself and the psychological climate in the family. Infant intestinal colic is a multifactorial symptom complex that requires differential diagnosis between norm and pathology. Until now, there is no clear understanding of the criteria for the need for dietary and drug correction of this condition. The article presents an analysis of the modern literature on the problem of intestinal colic in infants The pathogenesis of functional intestinal colic is determined by a combination of reasons, including the immaturity of the central nervous system, hypothalamic-pituitary system, regulation of the intestinal innervation and the enzymatic system, a certain dependence on psychosocial factors has also been identified, the intestinal microflora has a great influence. H. Kianifar et al. (2014) in the findings of a study noted that a multiprobiotic (seven strains of probiotics and fructooligosaccharides) significantly improved colic symptoms, in particular a reduction in crying time, (82.6%) compared with placebo (35.7%) on day 7 of intake (p &lt; 0.005). On day 30, treatment success was 87% and 46% in the synbiotics and placebo groups, respectively (p &lt; 0.01). The results of a domestic study by I.N. Zakharova et al. (2016) multiprobiotic, which showed that after the use of a multistrain probiotic, intestinal colic remained in 3 (10%) children of the main group and in all children in the placebo group. After taking the probiotic, 80% of children showed normalization of stool, and in the placebo group, stool disorders (loose, watery stools or no stool with the need to empty after an enema) were recorded in 87% of children. Cases from clinical practice with experience of using a multistrain probiotic for colic are shown.

TP6.1.7 Systematic review and meta-analyses of cholecystectomy as a treatment of biliary hyperkinesia

Abstract Aims Biliary hyperkinesia is typically diagnosed in patients with biliary like pain and no evidence of gall stones on imaging modalities but who have had biliary scintigraphy scan (HIDA) that shows ejection fraction ≥80%. This study aims to identify whether the removal of the gall bladder can alleviate the symptoms associated with Biliary Hyperkinesia. Methods Systematic search following PRISMA guidelines was done from inception to January 2020 using PubMed/Medline, OVID, Embase, Cochrane database of systemic reviews, Cochrane central register of controlled trials, The Database of Abstracts of Reviews of Effects (DARE) and Cochrane library databases. Results were expressed as risk ratios (RR) for dichotomous outcomes together with 95% confidence intervals (CI) or mean differences (MD) or standardized MD (SMD) for continuous outcomes. A meta-analysis done using random-effect model in RevMan 5.4® software. Results Thirteen studies met the inclusion criteria and were included in the review. A total of 332 patients diagnosed with biliary hyperkinesia underwent cholecystectomy, of whom 303 (91.3%) reported symptomatic improvement RR 8.67 [95% CI 4.95, 15.16] P = 0.01. Six studies described abnormal histological features in 163/181 (90.05%) with high GB EF. RR 7.88 [95% CI 3.94, 15.75] P = 0.08. Chronic cholecystitis n = 155 (95%), cholesterolosis n = 7 (4.3%), and one showed features of acute cholecystitis. Conclusion Patients with typical biliary colic symptoms without gallstones and markedly high ejection fraction might benefit from having cholecystectomy to alleviate their symptoms.

Role of probiotics and vitamins in maintaining a healthy gut microbiome: recent advances

While the concept of probiotics is not new, science based approaches to developing targeted probiotic products are a renewed interest. Probiotics and the microbiome is now being considered as having a blueprint of good health, unique to every human. Along with the well-known and established health benefits like reduced antibiotic associated diarrhoea and colic symptoms, eczema, necrotising enterocolitis, acute paediatric infections like diahorrea and upper respiratory tract infections; probiotics are now considered as beneficial for maintaining mental well-being as well. This new branch of disease management is now termed as Nutritional neuroscience and these beneficial gut bacteria are referred to as psychobiotics. It is important to identify the specific strains of probiotics and characterize them and conduct randomised controlled trials to establish these benefits. With emerging data related to role of vitamins in modulating the gut microbiome, combining pre and probiotics with micronutrients is likely to result in powerful functional foods boosting host immunity.

Biliary hyperkinesia in adolescents-it isn't all hype!

Biliary dyskinesia generally refers to a hypofunctioning gallbladder with an ejection fraction (EF) of <35% on hepatobiliary iminodiacetic acid scan with cholecystokinin stimulation (CCK-HIDA testing). In adults, biliary hyperkinesia has a defined association with biliary colic symptoms and can be relieved with surgical intervention. This clinical entity has not been well described in children or adolescents. In fact, only recently have we seen biliary hyperkinesia on HIDA at our centers. To that end, we reviewed our recent experience with adolescents who have presented and been treated for this unusual clinical entity. With IRB approval, we retrospectively reviewed the records of all patients with abnormally high HIDA EFs (>80%) cared for by the pediatric surgery services at two tertiary care centers over the span of a three-year period. Age, sex, BMI, CCK-HIDA results, and preoperative testing and post-operative pathology were noted. Resolution of symptoms was determined by subjective patient self-reporting at postoperative visit. Eighteen patients met inclusion criteria. Average age 15.7 (range, 10-17 years), median BMI 27.3 (±8.2). Fifteen patients were female and 3 were male. Average CCK-HIDA EF was 91.6% (±5.2), 82.4% of the patients had evidence of chronic cholecystitis and/or cholesterolosis on pathology. Postoperatively, 82.4% of the patients available for follow up (n=17) reported complete or near complete resolution of symptoms. Biliary hyperkinesia is an emerging clinical entity in children and adolescents and has a similar presentation to biliary hypokinesia. While the pathophysiologic mechanism of pain is not fully elucidated, laparoscopic cholecystectomy appears to provide a surgical cure for these patients and should be considered in the differential for the patient with an unremarkable workup and history suggestive of biliary colic.

Systematic review and meta-analyses of cholecystectomy as a treatment of biliary hyperkinesia.

Biliary hyperkinesia is typically diagnosed in patients with biliary-like pain and no evidence of gall stones on imaging modalities but who have had biliary scintigraphy scan (HIDA) that shows ejection fraction ≥ 80%. This study aims to identify whether the removal of the gall bladder can alleviate the symptoms associated with biliary hyperkinesia. Systematic search following PRISMA guidelines was done from inception to January 2020 using PubMed/Medline, OVID, Embase, Cochrane database of systemic reviews, Cochrane central register of controlled trials, The Database of Abstracts of Reviews of Effects (DARE) and Cochrane library databases. Results were expressed as risk ratios (RR) for dichotomous outcomes together with 95% confidence intervals (CI) or mean differences (MD) or standardized MD (SMD) for continuous outcomes. A meta-analysis was done using random-effect model in RevMan 5.4® software. Thirteen studies met the inclusion criteria and were included in the review. A total of 332 patients diagnosed with biliary hyperkinesia underwent cholecystectomy, of whom 303 (91.3%) reported symptomatic improvement RR 8.67 (95% CI 4.95, 15.16) P = 0.01. Six studies described abnormal histological features in 163/181 (90.05%) with high GB EF. RR 7.88 (95% CI 3.94, 15.75) P = 0.08. Chronic cholecystitis n = 155 (95%), cholesterolosis n = 7 (4.3%), and one showed features of acute cholecystitis. Patients with typical biliary colic symptoms without gallstones and markedly high ejection fraction might benefit from having cholecystectomy to alleviate their symptoms.

Symptomatic relief from at-home use of activated Bifidobacterium infantis EVC001 probiotic in infants: results from a consumer survey on the effects on diaper rash, colic symptoms, and sleep.

The gut microbiome during infancy is directly involved in the digestion of human milk, development of the immune system, and long-term health outcomes. Gut dysbiosis in early life has been linked to multiple short-term ailments, from diaper dermatitis and poor stooling habits, to poor sleep and fussiness, with mixed results in the scientific literature on the efficacy of probiotics for symptom resolution. Despite the growing interest in probiotics for consumer use, observed symptomatic relief is rarely documented. This study aims to evaluate observed symptomatic relief from at-home use of activated Bifidobacterium infantis EVC001 in infants. Consumer feedback was collected over a 2-year period via a 30-day post-purchase online survey of B. infantis EVC001 (Evivo®) customers. Outcome measures included observed changes in diaper rash, symptoms of colic, and sleep behaviours in infants fed B. infantis EVC001. A total of 1,621 respondents completed the survey. Before purchasing B. infantis EVC001, the majority of respondents visited the product website, researched infant probiotics online, or consulted with their doctor or other healthcare professional. Of the participants whose infants had ever experienced diaper rash, 72% (n=448) reported improvements, and 57% of those reported complete resolution of this problem. Of those who responded to questions about gassiness/fussiness, naptime sleep, and night-time sleep behaviours, 63% (n=984), 33% (n=520), and 52% (n=806) reported resolution or improvements, respectively. Although clinical data regarding probiotic use are often inconclusive for symptom resolution, home use of B. infantis EVC001 in infants improved diaper rash, gassiness/fussiness, and sleep quality within the first week of use in a significant number of respondents who engaged in a voluntary post-purchase survey. These outcomes may be a result of the unique genetic capacity of B. infantis EVC001 to colonise the infant gut highlighting the importance of strain selection in evaluating the effects of probiotic products.

Usefulness of endoscopic ultrasound in patients with minilithiasis and/or biliary sludge as a cause of symptoms of probable biliary origin after cholecystectomy

IntroductionEndoscopic ultrasound (EUS) is a more sensitive technique than transabdominal ultrasound for the diagnosis of gallstones. This greater sensitivity, especially in the diagnosis of microlithiasis/biliary sludge, facilitates the indication of cholecystectomy in patients with symptoms of probable biliary origin but may result in over-indication of this surgery. ObjectivesEvaluate the role of EUS in the diagnosis of minilithiasis/biliary sludge in patients with digestive symptoms of probable biliary origin by resolving the symptoms after cholecystectomy. Analyse factors related to the remission of symptoms following cholecystectomy. Patients and methodsRetrospective, longitudinal, single-centre study based on a prospective database of 1.121 patients undergoing EUS. Seventy-four patients were identified as meeting inclusion-exclusion criteria (diagnosed with minilithiasis/sludge by EUS after presenting digestive symptoms of probable biliary origin without a history of complicated cholelithiasis). A telephone questionnaire for symptoms was conducted with cholecystectomized patients. Factors related to a good response were analysed with logistic regression analysis. ResultsOf the 74 patients, 50 were cholecystectomized (67.5%), mean age 49 years (SEM 2.26) (41 women). Seventy percent of patients (35/50) presented remission of symptoms with median follow-up 353.5 days (95% CI, 270–632.2). The only variable associated with remission of symptoms was the presence of typical biliary colic with an OR of 7.8 (95% CI, 1.8–34; p=0.006). No complications associated with EUS were recorded. One patient (2%) suffered haemoperitoneum and 18% (9/50) suffered diarrhoea following cholecystectomy. ConclusionsEUS is a very useful technique for the indication of cholecystectomy in patients with minilithiasis/sludge and typical symptoms of biliary colic.